Imagine No More Nurses

Recruiting foreign nurses to cover staffing shortfalls is local hospitals' latest healthcare Band-Aid. But the crisis only grows.

"There's no reason," he continues, "why you couldn't create a program that could take a nurse's aide and give them work-study credit to advance to a two-year nursing program, or a four-year nursing degree. You could offer an accessible career ladder for people who have relatively few workable career ladders on the way up to the middle class."


Although some immigrants, from Africa, Asia, and Eastern Europe, struggle to make ends meet in low-paying positions, others, like Michael and Elizabeth deVera, are coveted and lured into coming to America.

Pamela Valfer

"Even though there are openings here in America, I am not interested in coming here. I will just miss my family. I'm a home... home... What do you call that?" murmurs Elizabeth deVera, who, at 27, could pass for a teenager. (Her HealthEast employers, sitting beside her as she talks, quickly assist her with the term, "homebody.") "But then I met Michael."

Her husband had no such reservations.

"There's this goal of coming over," says 30-year-old Michael deVera, large brown eyes beaming as he flashes a winsome smile. "There's an opportunity to advance. And I already serve my country, sending our hard-earned money for our families."

The Philippines is a special case. Unlike most countries, the Philippines has a surplus of nurses. In fact, the Filipino government encourages citizens to go into nursing for the sole purpose of going overseas, so they can send money back to their homeland. (Exporting employees, from nurses and engineers to hairdressers and farmers, generates billions of dollars for the Philippines each year; Wired reported last year that remittances from Filipinos working overseas make up as much as eight percent of the country's gross national product.) It's no wonder, then, that recruiters from the United States, Europe, and the Middle East gladly converge on the South Pacific archipelago to entice nurses to their countries.

Recruiting from the Philippines does require time and money--it can take up to two years for the nurses to jump required immigration and licensure hurdles--but for Twin Cities hospitals it's less expensive than paying excessive signing bonuses to local nurses or paying exorbitant fees for temporary-agency workers when staffing levels fall dangerously short. Besides, once the nurses are here, the investment tends to pay off. At HealthEast, for instance, the Filipino nurses have a 40-month contract with the hospital system.

Abraham Abbariao, whose company Midwest Clinic Management brought the nurses to HealthEast, began recruiting nurses from his Filipino homeland quite by accident. His Bloomington-based consulting firm had worked with HealthEast, and a few years back, when the system began looking into international recruiting, Abbariao offered to scout out the Philippines. Now, he has sprouted an ancillary business doing just that kind of recruiting, having hired 100 nurses, with nearly 400 more ready to be interviewed for positions in Kentucky, North Carolina, and New York. "It's the choice for U.S. hospitals," he says matter-of-factly. "To have nothing, or have something."

But the popularity of the Filipino panacea raises concerns. The Minnesota Nurses Association, for instance, worries that once nurses arrive, from the Philippines or other countries, they may not be given the support they need to adjust to their new country. Moreover, critics challenge the overseas recruitment, calling it unscrupulous for the United States to pillage Third World countries for its own gain. Even though the Philippines may have a surplus of nurses today, that is not always the case in countries where the U.S. recruits nurses, including South Africa.

"If we're recruiting [from overseas] just to handle a nursing staffing crisis at bedside, we do have a problem with that. America is putting its interest ahead of others' to the point of being unethical," says Jan Rabbers, spokeswoman for the Minnesota Nurses Association. "We have got to grow nurses. We have got to keep nurses. We have got to change health care."


A start, says Joanne Disch, a professor and administrator at the University of Minnesota's School of Nursing, would be devoting more resources to train new nurses. And, even more important, nursing schools need an influx of funds to train nursing faculty, a population that's also dwindling.

But it's more than just creating new nurses, Disch adds. To keep those nurses from burning out, hospitals and healthcare systems need to fundamentally change their environments. The dogmatic hierarchy needs to change and nurses must be able to collaborate more with physicians in the administration of health care. "Nurses need to be more fully integrated into the organizations in which they are practicing," she says. "Nurses want more control over their schedules. They want to have a say in how things are decided with regard to patient care."

On that point, Kip Sullivan agrees. "Pay ought to be increased," he says. "Nurses ought to have more authority."

Beyond that, he insists that forcing hospitals to control spiraling costs and restructuring the health insurance industry can go a long way to solving the nursing shortage.

Of the $1.5 trillion spent annually on health care in the United States, anywhere from 20 to 40 percent is wasted on out-of-control administrative costs, excess hospital beds, underused expensive equipment, and outrageous drug prices, Sullivan argues. "Compared to the $300-$450 billion being wasted, I am positive that the amount of money it would take to get nurse-patient ratios up to safe levels is a pittance," he says. "If we controlled drug prices, we could save enough money to solve the nursing shortage."

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